|
 |
"Infection Control for
Viral Haemorrhagic Fevers
In the African Health Care Setting"
Section 9. Make Advance
Preparations to Use VHF Isolation Precautions
This
section describes how to:
- Identify health
facility staff person to coordinate VHF activities.
- Assess current
readiness for VHF Isolation Precautions.
- Identify and train
key staff who will work with VHF cases.
- Plan for community
mobilization.
- Assess current
supplies and obtain what is needed for VHF Isolation Precautions.
- Use substitutions
when supplies are limited or not available.
When
a VHF case is suspected, VHF Isolation Precautions must begin immediately.
All efforts must be focused on meeting patient's needs. There is no time
to give initial training in VHF Isolation Precautions.
Being prepared for an emergency can ultimately save lives. Health care
workers will know how to use VHF Isolation Precautions, and adequate supplies
will already be available. Disease prevention in the health facility setting
will be more effective. This section describes how to prepare for VHF
Isolation Precautions.
| 9.1
Identify a VHF Coordinator to Oversee Preparations |
 |
Someone
in the health facility may already serve as a coordinator for emergency
situations. This person can also serve as the VHF Coordinator. If the
emergency coordinator cannot assume the VHF activities, select a staff
person with authority who can serve as VHF Coordinator. Discuss the tasks
the coordinator will need to do for VHF activities:
- Oversee all the
preparations for VHF Isolation Precautions.
- Serve as the focal
point for information and leadership when a VHF case is suspected.
- Inform all health
facility staff about VHFs and the risks associated with them.
- Organize training
in VHF Isolation Precautions for medical, nursing, and laboratory staff
who will work directly with VHF patients or infectious body fluids.
- Assign responsibility
to medical, laboratory, and cleaning staff for ensuring that all the
necessary precautions, treatment protocols and cleanup procedures are
carried out within their areas.
- Hire or reassign
and train additional cleaning staff for work with disinfection of waste,
clothing, and equipment.
- Make sure that
teams are trained to prepare and transport bodies for burial.
| 9.2
Assess Current Readiness for VHF Isolation Precautions |
|
Be prepared
to use VHF Isolation Precautions by identifying problems and actions to
solve them. Make sure relevant staff know how to suspect a VHF, especially
those who:
- See patients when
they arrive at the health facility and decide where they are next seen
- Work in the outpatient
department
- Work in the emergency
room.
| 9.2.1
Monitor Routine Handwashing Practices |
Routine
handwashing practices should be part of the minimum level of Standard
Precautions used with all patients in the health facility.
To reinforce
consistent handwashing practices, regularly monitor the practices and
improve them as needed. For example:
- Has handwashing
been identified as a routine practice in the health facility?
- Do all staff wash
their hands after contact with each patient, especially new patients
with fever?
- Are there reliable
supplies of soap and running water or buckets with clean water available
in areas where health workers should use them?
- Are posters reminding
health workers to wash their hands placed in areas where health workers
can see them
| 9.2.2
Assess Readiness for Identifying Suspected VHF Cases |
Assess the need for
training your health staff to suspect a VHF. For example:
- Do health care
workers know the case definition for identifying VHF cases that have
occurred in your area?
- Do health care
workers know the procedure for informing the emergency or VHF Coordinator
when a VHF is suspected?
- Do health care
workers in the relevant areas know the level of Standard Precautions
identified for the health facility? Do they use them all the time to
prevent health facility transmission of VHFs and other contagious diseases
such as HIV and hepatitis B?
| 9.2.3
Assess Readiness for Setting Up a VHF Isolation Area |
- Has an area been
selected for VHF isolation that meets the criterion described in Section
3.1?
- Has a map been
drawn showing where to locate the changing room, the patient room, the
changing room for the cleaning staff, and a changing room for family
members (if needed)?
A map that is prepared
in advance can be used as a reference for setting up a VHF isolation area
in an urgent situation.
| 9.2.4
Assess Readiness of Medical, Laboratory, and Cleaning Staff |
Key staff should
be identified and informed about what will be expected of them when a
VHF case is suspected. For example:
- Is there a family
liaison officer who will:
- Provide information
and help families to care for the patient
- Help families
find a place near the hospital where cooking, sleeping, and sanitary
facilities are available
- Talk with
family members about their concerns?
- Have the health
care workers who will have access to the isolation area if a VHF case
is suspected been identified? While all health facility staff should
know and use Standard Precautions consistently, identify the health
care workers who must also know how and when to use VHF Isolation Precautions.
- Have laboratory
staff been designated to work with VHF samples? Laboratory staff are
at particular risk of disease transmission because they handle biological
samples. They do not see the patients and cannot know if the sample
is infected with a dangerous disease. When a VHF case occurs, limit
work on VHF samples to one laboratory staff person who will do all testing
of body fluids from VHF patients. Make sure the designated person knows
when and how to use protective clothing and safely disinfect spills
and waste.
- Have cleaning
staff been selected and trained to use VHF Isolation Precautions? Cleaning
staff have close contact with infectious spills and equipment. They
are at high risk of transmission if VHF Isolation Precautions are not
used. Select the cleaning staff who will be responsible for cleaning
in VHF isolation areas, laundry areas, and the body preparation area.
- Have body disposal
teams been identified and trained to use VHF Isolation Precautions?
The health facility staff or Red Cross volunteers who prepare corpses
before families claim them are at risk for VHF. The VHF patient is still
contagious for several days after death.
The VHF Coordinator
should also meet with each group to explain the risk of health facility
transmission and the training schedules and to answer any questions they
have.
| 9.3
Train Health Facility Staff in VHF Isolation Precautions |
|
Learning
to use a new skill takes time and practice. Health facility staff who
do not know how to use VHF Isolation Precautions will need information
about the new tasks, see them demonstrated and practice doing them. Staff
who are not familiar with protective clothing should practice putting
them on and working in them before a VHF case presents.
Include
information about VHFs and using VHF Isolation Precautions during in-service
training.11 Discuss topics such as:
General
information about VHFs
- A VHF can be caused
by several different viruses, which are transmitted to humans by animals
or arthropods.
- Each virus causes
a different disease, but all attack the small blood vessels that carry
blood through the body.
- The virus is usually
in all organs and can cause bleeding from the nose, mouth, and intestine,
as well as under the skin.
- Common presenting
complaints are fever, body aches, weakness persisting after rehydration,
diarrhoea, muscle pain and back pain.
- Clinical examination
may reveal only conjunctival injection (red eyes), mild hypotension
(low blood pressure), flushing, and haemorrhages.
- The course of
VHF leads to shock, generalized mucous membrane bleeding, reduced sensitivity
to pain, and signs involving the nervous system.
- Examples of VHFs
include:
Africa: Lassa fever, Rift Valley fever, Marburg and Ebola haemorrhagic
fevers, Crimean-Congo haemorrhagic fever, and yellow fever.
South America: Argentine haemorrhagic fever, Bolivian haemorrhagic
fever, Venezuelan haemorrhagic fever, haemorrhagic fever with renal
syndrome (rare), yellow fever, and dengue haemorrhagic fever.
Asia: Haemorrhagic fever with renal syndrome and dengue haemorrhagic
fever.12
VHF
Transmission Risk in the Health Facility:
Give
information about VHF, its transmission, and previous outbreaks in the
area listed in the Introduction and Section
2 of this manual. Explain that:
- The virus is present
in the patient's body fluids.
- It is transmitted
through unprotected contact between an infectious patient or their body
fluids and a non-infected person.
- While VHF is not
a common diagnosis, it is a dangerous disease and poses significant
risks in the health care setting.
VHF
Isolation Precautions:
When a VHF case is suspected, the health facility will immediately take
steps to limit its transmission. These include steps to:
- Create an isolation
room for VHF patients.
- Limit contact
with VHF patients to a small number of specially trained staff and,
in some areas, a family member who has received information and training
in VHF Isolation Precautions.
- Limit the use
of invasive procedures as much as possible in treatment of VHF patients.
- Use protective
clothing for all staff who have contact with VHF patients or their body
fluids.
- Use safe disinfection
and waste-disposal methods.
Procedures
for Accidental Exposures:
Provide information about how to respond when accidental exposures occur.
These procedures are detailed in Section
5.13 of this manual.
| 9.4
Plan for Community Mobilization |
|
Section
8 describes how to mobilize the community in an urgent situation.
However, community mobilization will be easier and occur quickly if it
is planned in advance.
Now is the best time
to establish a Mobilization Committee. The following steps can be done
in advance.
- Identify key community
resources.
- Identify key
organizations and record them on the Community
Information Sheet (page 105).
- Identify the
representative or leader for each organization.
- Contact the
representative or leader for an initial meeting.
- Meet with identified
community leaders.
- Give information
and educate them on VHFs.
- Explain the
purpose for a Mobilization Committee.
- Discuss and
clarify each organization's expertise.
- Discuss and
clarify the human resources available from each organization.
- Discuss and
clarify equipment available from each organization.
- Establish
methods for communicating between the Mobilization Committee and
the VHF Coordinator.
- Record the
relevant information on the Community Information Sheet.
- Annually update
the information on the Community Information Sheet.
Then, when a VHF
case is suspected, the committee can meet and take action to mobilize
resources and carry out community education.
| 9.5
Assess Current Supplies and Equipment |
|
Use
the checklist at the end of this section to assess which supplies are
already available in the health facility. If these supplies are available,
can they be set aside for use when VHF Isolation Precautions are needed?
If they are not available, could they be borrowed from another service
if an outbreak occurred?
If the
supply is limited or unavailable, identify practical, low-cost substitute
items. When an item or equipment is not available, consider what could
be used in its place that will serve the same function. Obtain the substitute
item now. Set it aside for use when VHF Isolation Precautions are needed.
For
example, assess the present system for waste disposal. Find out what is
needed to carry out safe waste disposal when a VHF case is suspected.
Ask health facility staff to prepare an incinerator (if none is available)
so it is ready in advance. Let health facility staff practice using it
before cases occur.
The
checklist that starts on the next page lists the necessary items and recommended
quantities. Use it to assess whether an item is available. Also list what
needs to be done to be prepared for VHF Isolation Precautions.
| 9.6
Periodically Reassess Supplies |
|
Periodically, for
example, every 4 months, make sure the supplies are dry, clean, and ready
to be used.
 **For
easy print versions of the following supplies lists, please refer to the
PDF version of this document.
VHF Isolation
Precautions Supplies: Standard Precautions: Recommendations for handwashing
and safe disposal of sharps*
| Recommended
Item |
Recommended
Amount |
Amount
Available |
Amount to Obtain |
Local Adapta-tions
|
Item Ready
to
use?
|
| Source of clean
water |
prepared as
needed |
|
|
|
|
| Container for
daily supply of water for handwashing |
1 or 2 large
containers |
|
|
|
|
| Ladle |
several |
|
|
|
|
| Bucket or pan
for use with handwashing |
1 for each location
in the health facility |
|
|
|
|
| Pieces of soap |
several bars
cut in pieces |
|
|
|
|
| Soap dishes
|
1 for each handwashing
station |
|
|
|
|
| One-use towels
|
1 roll per health
worker per week |
|
|
|
|
| Sharps containers
|
1 for each location
where sharps are used |
|
|
|
|
| Pans with soapy
water to collect needles and syringes for reuse |
1 for each location
where sharps are used |
|
|
|
|
| Pans with full
strength bleach |
1 for cleaning
area |
|
|
|
|
| Supply of clean
water for rinsing needles and syringes |
1-5 liters |
|
|
|
|
| Clean and disinfected
jars for storing disinfected needles |
1 for each patient
isolation area |
|
|
|
|
*This is a
recommended minimum level of Standard Precautions for use with all patients
regardless of their infectious status.
VHF Isolation
Precautions Supplies: Patient Isolation
Recommended
Item |
Recommended
Amount |
Amount Available
|
Amount to Obtain |
Local Adapt-ations
|
Item Ready
to use? |
| Bed |
1 per patient |
|
|
|
|
| Mattress or
sleeping mat |
1 per patient |
|
|
|
|
| Plastic sheet
to cover mattress |
1 per bed |
|
|
|
|
| Bedding: bottom
sheet and blanket |
1 each per patient |
|
|
|
|
| Thermometer |
1 per patient
isolation area
(if available) |
|
|
|
|
| Stethoscope |
1
per patient isolation area |
|
|
|
|
| Blood pressure
cuff |
1 per patient
isolation area |
|
|
|
|
| Covered container
for alcohol or bleach solution used to disinfect thermometer and stethoscope |
1 per patient
isolation area |
|
|
|
|
| Sharps container
or plastic pan with bleach solution for disposal of used needles |
1 per patient
isolation area |
|
|
|
|
| Bedside table
or shelf |
1 per patient
|
|
|
|
|
| Large wall clock
with seconds hand |
1 per patient
isolation room |
|
|
|
|
| One-use towels
|
1 roll per patient
per week or stay |
|
|
|
|
| Bed pan |
1 per patient
|
|
|
|
|
| Screens placed
between patients' beds |
enough length
to go around isolation area |
|
|
|
|
| Signs saying
"Isolation Area: No Access" |
10 |
|
|
|
|
| Poster describing
Isolation Precautions |
1 |
|
|
|
|
VHF Isolation
Precautions Supplies: Protective Clothing*
| Recommended
Item |
Recommended
Amount |
Amount Available
|
Amount to Obtain |
Local Adapta-tions
|
Item Ready
to
use? |
| Scrub suits
|
1-2 reuseable
suits per health staff |
|
|
|
|
| Surgical gowns
|
3 reusable gowns
per staff, 4 disposable gowns per staff per week |
|
|
|
|
| Plastic aprons
|
1 reusable
apron for each staff who needs one,
3 disposable aprons per staff per week
|
|
|
|
|
| Thin gloves
|
3 dozen disposable
pairs per health staff per week |
|
|
|
|
| Thick or heavy-duty
kitchen gloves |
2 pairs per
staff |
|
|
|
|
| HEPA-filter
or other bio-safety mask |
1-2 per staff
who needs one |
|
|
|
|
| Cotton mask
|
3-4 per health
staff |
|
|
|
|
| Rubber boots
|
1 pair per staff |
|
|
|
|
| Headcovering |
1-2 per staff
who needs one |
|
|
|
|
| Eyewear |
1 pair of goggles
or clear spectacles per health staff in isolation area |
|
|
|
|
| Shelf or cabinet
with lock |
1 outside changing
room |
|
|
|
|
| Covered shelf
for storing disinfected boots |
1 outside changing
room |
|
|
|
|
| Hooks, nails,
or hangers for hanging reusable scrub suits and gowns |
1 for each health
staff |
|
|
|
|
| Boot remover
|
1 per changing
room |
|
|
|
|
| Rolls of plastic
tape |
1 per changing
room |
|
|
|
|
| Extra supply
of clean protective clothing (for patient isolation area) |
1-3 sets |
|
|
|
|
| Extra supply
of clean protective clothing (for changing room) |
1-3 sets |
|
|
|
|
*All health facility
staff - including cleaning, waste disposal, and laundry staff - who handle,
disinfect or clean VHF-contaminated supplies and equipment should wear
the same protective clothing as health care workers who provide direct
patient care.
VHF Isolation
Precautions Supplies: Disinfection
| Recommended
Item |
Recommended
Amount |
Amount
Available |
Amount
to Obtain |
Local
Adapta- tions |
Item
Ready
to
use? |
| Supplies for
preparing disinfectants |
|
|
|
|
|
| Plastic bucket
with lid or cover for preparing 1:10 bleach solution |
|
|
|
|
|
| Containers for
preparing 1:100 bleach solutions |
1 large container
or several small ones |
|
|
|
|
| Measuring cup
|
1 with measurements
marked on it |
|
|
|
|
| Bleach |
1 liter bleach
yields 100 liters of 1:100 bleach solution |
|
|
|
|
| Supplies for
disinfection station (changing room and patient room) |
|
|
|
|
|
| Pan or bucket
with 1:10 bleach solution |
1 per each disinfection
station |
|
|
|
|
| Pan
or bucket with 1:100 bleach solution |
1
per each disinfection station |
|
|
|
|
| Pan or bucket
with 1:100 bleach solution for collecting reusable gloves |
1 per changing
room |
|
|
|
|
| Bucket or bag
for collecting contaminated, reusable protective clothing |
1 per changing
room |
|
|
|
|
| Bucket or bag
for collecting patient's contaminated laundry |
1 per patient
isolation area |
|
|
|
|
| Pan with soapy
water for collecting used needles and syringes |
1 per patient
isolation area |
|
|
|
|
| Sprayer, bucket
or shallow pan with 1:100 bleach solution for disinfecting boots |
1 for the disinfection
station in patient room |
|
|
|
|
| Sprayer, 1:100
bleach solution, clean water for disinfecting spills on floor or wall |
1 per each disinfection
station |
|
|
|
|
| Mop |
1 per each disinfection
station |
|
|
|
|
| Supplies
for laundry |
|
|
|
|
|
| Bucket with
1:100 bleach solution |
2-3 (10-30 liters
of bleach solution needed daily) |
|
|
|
|
| Buckets with
soapy water |
2-3 (10-30 liters
of bleach solution needed daily) |
|
|
|
|
| Source of clean
water for rinsing laundry |
10-30 liters/
day |
|
|
|
|
| Needles
and thread for repairing holes in protective clothing |
5
spools and 5 needles |
|
|
|
|
| Talcum powder
to put in washed gloves |
1 tin |
|
|
|
|
| Line to air-dry
reusable clothes |
|
|
|
|
|
VHF Isolation
Precautions Supplies: Waste Disposal
| Recommended
Item |
Recommended
Amount |
Amount Available
|
Amount to Obtain |
Local Adapta-
tions |
Item Ready
to
use
|
| Containers with
1:100 bleach solution for collecting infectious waste |
1 per patient
isolation area |
|
|
|
|
| Pit or incinerator
for burning infectious waste* |
1 per facility,
pit should be 2 meters deep |
|
|
|
|
| Kerosene or
petrol |
1 liter per
week |
|
|
|
|
| Wood for burning |
|
|
|
|
|
| Rope to make
barrier around the waste disposal site |
enough length
to go around the waste disposal site |
|
|
|
|
* If no incinerator
is available, make one from an empty 220-litre (55-gallon) oil or fuel
drum
VHF Isolation
Precautions Supplies: Safe Burial Practices
| Recommended
Item |
Recommended
Amount |
Amount Available
|
Amount to Obtain |
Local Adaptations
|
Item Ready
to use |
| Supply of 1:10
bleach solution |
prepared as
needed |
|
|
|
|
| Sprayer |
1 |
|
|
|
|
| Body bags (cotton
cloth, plastic, sheeting, plastic tape) |
as needed |
|
|
|
|
VHF Infection
Control Supplies: Other
| Recommended
Item |
Recommended
Amount |
Amount Available
|
Amount to Obtain |
Local Adaptations
|
Item
Ready
to use? |
| Supply checklist
|
as needed |
|
|
|
|
| Patient record
form |
as needed |
|
|
|
|
| Accidental exposure
record forms |
as needed |
|
|
|
|
| Training
materials for staff training in VHF Isolation Precautions |
as
needed |
|
|
|
|
|
 |
|
|
| Infection
Control For VHFs Manual |
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|
| Sections
on this page |
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